A fixed fantasy is a belief that cannot be confirmed, seen most commonly in patients with personality disorders. This is also referred to as a dysfunctional schema, and can involve patterns established very early in childhood. For example, a patient may be convinced that she is a horrible person and everyone around her hates her, even though there is ample evidence to the contrary. Treating patients with fixed fantasies can be complex, involving an exploration of the events that led to the formation of the dysfunctional schema as well as attacking the belief or interconnected beliefs directly.

People with anxiety and depression can also develop fixed fantasies. Some are very fatalistic in nature; the patient may feel worthless or undervalued by friends or family. Such beliefs can also play a role in self-harming and suicidal behavior, where patients may feel like they need to punish themselves or think their deaths would spare the people around them pain and suffering. A patient who feels evil and irredeemable, for example, may believe that suicide would be an appropriate action.

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Early childhood may lay the groundwork for a fixed fantasy; children who have experienced abuse, neglect, and molestation, for example, may develop beliefs with no grounding in reality as a coping mechanism. A child who was abused, for instance, might have a fixed fantasy that he is bad and was simply being punished for his unacceptable behavior. As the child develops, the fixed fantasy can trigger repetitive behaviors which reinforce it and convince the patient that the belief is correct.

In other cases, fixed fantasies develop without a clear cause. Patients with personality disorders, for example, can be convinced that other people dislike them and are conspiring against them, but may not have a specific history of experiences that might have sown the seeds for this belief. This can become a fixation which interferes with daily living; a patient who thinks everyone is conspiring, for example, assumes that people whispering in the office are plotting something and has trouble focusing at work.

Schema therapy is one method of addressing a fixed fantasy. In this approach to psychotherapy, patient and therapist work together to explore the origins of a schema, dismantle it, and cultivate more healthy beliefs. Some patients find it helpful to take medication to address psychological symptoms like anxiety while they are in therapy, because these symptoms can distract from the sessions and make it hard to focus.

Discuss this Article

browncoatPost 3

@pleonasm - It's funny how it almost manages to make someone feel like they are special, even if it's only that they are the worst, or the person with the most pain, to the point where rules no longer apply to them.

I guess it's probably got something to do with people not developing enough ability to empathize with others, to the point where they really don't understand how others think and just assume that the world revolves around themselves.

pleonasmPost 2

@bythewell - I remember after one of the school shootings they had an expert on the television and they asked him how anyone could ever do something like that.

He basically said that it might be that the person has convinced themselves that they are in so much pain that no one could possibly understand it unless they tried to make the world on the outside look as bad as it felt on the inside.

That's an extreme example, of course, but I think it shows how terrible this kind of thinking can be.

bythewellPost 1

This might actually be fairly common. I know I always thought that everyone secretly didn't like me very much and just tolerated my presence when I was a teenager. It is very difficult to prove or disapprove this kind of idea, because even if people say they don't think that about you, you will just think that they are lying.

I eventually convinced myself that I was being really disrespectful to my friends by thinking that they were lying to me or even that they bothered to spend time with someone they disliked. But I can definitely see how it might be more difficult to dislodge this kind of idea for some people.

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